Clients determine the quality and value of your veterinary practice based on what they see and observe – and it can happen in just minutes of entering your practice. This is known as Perception of Value. To evaluate your practice’s Perception of Value, you need to put yourself in your client’s shoes and look at things from their perspective.
In Part II, we’ll look at how your facility, niche marketing, wait times and exam room experience impact your clients’ perception of value.

Clients determine the quality and value of your veterinary practice based on what they see and observe upon entering your practice. This is what is known as Perception of Value, defined as “The determination made by clients regarding the quality and value of services rendered to them and their pets”. To evaluate your practice’s Perception of Value, you need to put yourself in your client’s shoes and look at things from their perspective. In Part I, we looked at your online presence, receptionists, and signage. Now let’s look at your facility, niche marketing, client wait times, and the exam room experience.


Look at your building and the outside physical environment surrounding it. Is the building well maintained? How about your landscaping? If you have dead plants in front of your practice, clients may wonder how well you will do with their pet. The appearance of your parking lot, building, landscaping and general outside physical environment has a significant impact on your practice’s perception of value.

When clients enter your practice is there an unpleasant odor? Cleanliness and odor control are paramount to a high perception of value. Do you have comfortable seating in your reception area? Are all the pictures and posters professionally framed and hung on the wall or do you have things that are taped or tacked to the wall? What image does this convey to your clients? Would you tape posters up on the wall of your own home? I think not, but many veterinarians do in their “professional” offices.

I might suggest that you have a client convenience center in your reception area. You can offer coffee, bottled water, and perhaps some snacks. Clients really appreciate these little amenities. I also like to think about the children, how about having a children’s area with some toys or activities? To foster client education, I also like to have a flat panel television affixed to the wall of my reception area. Use it to play your practice’s virtual tour or maybe a video on the day in the life of a pet having a medical or surgical service performed in your practice. You can also just play some fun videos that might help make the wait time and the visit that much more enjoyable for the client.

Niche Marketing

The best way to explain and understand niche marketing is to look at the hotel industry:

Have you ever stayed at a Marriott hotel? How much did it cost per night – $200 or perhaps $300 per night? Let’s think about that experience. What were the building and parking lot like at that Marriott? Normally, the building will be very modern, landscaping will be impeccable, parking more than adequate, everything will be clean and inviting. Next, let’s walk into the lobby of the Marriott, what was that like? In most Marriott’s you find a beautiful lobby, perhaps with glass elevators, marble floors, and granite countertops. The desk clerks will be in uniform and hopefully have excellent customer service skills. You get your key and proceed to your room, upon entering the room you will note that it smells great, it is roomy with luxurious linens, a large flat-screen TV, extra fluffy towels, and all the amenities you will need. The Marriott will also have a restaurant, pool, health facilities, and other guest services.

Down the road from the Marriott, there is another hotel by the name of Motel 6. Have you ever stayed in a Motel 6? How much does it cost a night? Probably somewhere around $69 per night. And according to Tom Bodett, they’ll leave the lights on for you. When you drive up to the Motel 6 it is not going to be quite as impressive as the Marriott. There probably won’t be much, or any, landscaping outside the building. When walking into the lobby of the Motel 6 you might find a few chairs and you might have to ring the bell on the counter to get someone’s attention. Once you get the key and proceed to your room, you will find a smallish room with a bed, a television, towels in the bathroom (though not likely what you would describe as plush), and a very small bar of soap.

And do you know what is interesting? Every night both hotels fill up. Those that want Marriott will find a Marriott and spend $250 a night, those that want a Motel 6 will find a Motel 6 and spend $69 a night. Neither one is right or wrong, good or bad – it’s niche marketing.

There are many examples of niche marketing. Some people buy their eyeglasses or contacts at Costco, Walmart or Lens Crafters, while others go to a private ophthalmologist. Again, one is not right or wrong – they are just different consumer choices. Another example would be haircuts. Some people spend several hundred dollars to have their hair done and others spend $20 or $30. Or in my case – zero!

As you may have guessed, the same concept of niche marketing applies to veterinary hospitals. A client can choose a “Marriott” quality veterinary hospital (and I hope they will get “Marriott” quality care and service for their pet) or they can choose a “Motel 6” quality veterinary hospital and get “Motel 6” quality care and service. Not right, not wrong, just niche marketing. But you would not go into a Marriott expecting low-cost services and you would not go into a Motel 6 expecting top-end accommodations, they serve different markets.

Unfortunately, what I have found in many veterinary hospitals is that they don’t understand this concept of niche marketing and they attempt to be everything to everybody and, in the process, lose their niche and identity. I think the key to the success of any business is to identify your niche. A Marriott will not have low-cost services or low-cost room rates one day a week, just as a Motel 6 will not be charging $200 a night for their hotel rooms. There are many different niches. Think again about the hotel industry, at the very high end you have the Ritz Carlton, under that maybe Four Seasons, then Marriott, under that is Holiday Inn, then comes the Motel 6 followed by the hotel you pay for by the hour! They all serve a different niche. What niche would you put your practice in? To be successful, you need to identify your niche, be true to that niche and not only meet, but exceed your client’s expectations.

Wait Times

Do you know the number one reason why clients become upset and leave a practice? Wait time! So, the question must become, “How long is too long?” How long will a client wait before they become angry and perhaps decide they will not return to your practice? Many studies have been done on this topic and the answer is about 15 minutes. On average, a client will wait for 15 minutes before seeing the doctor or exam room technician, any longer than that and you are jeopardizing that client relationship and they may decide not to come back to your practice.

There are many techniques that can be used to minimize client wait time, my favorites are 10-minute flex scheduling and using “E” slots in the appointment schedule. 10-minute flex scheduling is setting up your appointment schedule in 10-minute increments. Once you have done this, you can schedule, 10-, 20-, 30- or even 40-minute appointments depending on the appointment type. For instance, you can use 10-minutes for a medical progress exam (great term instead of re-check) and 20-minutes for a wellness comprehensive physical exam and vaccination visit. You can even schedule 40 minutes for that Iguana that has a nutritional problem. Naturally, you will charge appropriately depending on the length of the visit.

E” slots, on the other hand, are pre-designated appointment times that are blocked out and kept open until the day of appointment. Then, on that appointment day, they can be used for client perceived emergencies or, if not used, they become a buffer zone or catch-up time, so that the doctor can get back on schedule. I think there should be at least one “E” slot allotted per doctor per session. So, if we have two doctors scheduled in the morning, each of them should have an “E slot” scheduled in the middle of the morning, and if we had three doctors scheduled for appointments that afternoon, each doctor would have an “E slot” scheduled in the middle of their afternoon appointments.

Exam Room Experience

Finally, in our discussion of perception of value, the client is going to visit your exam room. That is likely the reason they have come to your practice in the first place. What is the experience like when they enter your exam room? Just as with your reception area, the exam room must be clean and odor-free. Everything on the walls needs to be professionally framed and affixed to the wall, seating needs to be comfortable. Many exam rooms I visit appear cluttered. You get a lot of client information and handouts from vendors, but it does not necessarily have to be in your exam rooms.

One of the things that I and our consultants at VMC have done frequently over the past several years is setting up video cameras in the exam rooms and monitoring what occurs. This is not done covertly, quite the opposite, all employees are informed and ask to sign a release form and there is a sign in the exam room stating that the exam room is under video surveillance.

Do you have any idea what your clients are doing in the exam room when you are not there? Do you know what your exam room techs or assistants are doing? How about your doctors? It has truly been an eye-opening experience to see what goes on in the exam room. We have seen clients rummage through your drawers, one even took a handful of syringes and placed it in her purse. Some exam room assistants are excellent in their communication and others are not very good. I think the most interesting has been the doctors. Some doctors have amazing exam room communication – they exude professionalism, they make the client feel at home, they do a great comprehensive physical exam while educating the client about their findings, and they make the appropriate recommendations. Other veterinarians don’t do very well. I have seen many veterinarians who do not perform a comprehensive physical exam in front of the client and, if they do, often don’t verbalize it – so the client doesn’t even know the exam happened.

Sixty percent of our communication is body language. In some exam room videos, the doctor exhibits excellent body language while others are less confident. Also very telling is the way in which recommendations are communicated. One veterinarian might say, “You should consider getting those teeth cleaned sometime in the future.” Another doctor might say, “Take a look at these teeth. We really have a lot of tartar buildup and early periodontal disease. We need to get these teeth cleaned as soon as possible.” Of course, client response to these two different types of recommendation is night and day. Video reviews have often helped a doctor to improve upon their professional client transaction, many times increasing it $20 – $40 per transaction. Or better stated, by $60,000 to $120,000 a year!

I am not sure why more practices do not perform video evaluations of their exam rooms. It is not expensive, and it is an amazing tool. If you were to give me a tool that would guarantee to improve my performance and make me better at what I do, I would jump at it. That is what video evaluations do for veterinarians in the exam room.

Once the client is done in the exam room, they will return to the reception desk to check out. This is a critical point in the perception of value process. By this time the client is ready to get out of your practice. Is the invoice ready? Is the medication ready? Are we efficient? At this point, every minute the client is required to wait is perceived to be equivalent to 4 minutes in their mind. One last point – I never want my receptionist to tell the client that the invoice was $420 or whatever the amount is. Instead, I would like my receptionist to say, “Mrs. Jones, may I review with you the services that were rendered to Fluffy today?” If the client says, “Yes”, then that invoice needs to be thoroughly reviewed with them. If they say, “No, I am in a hurry today,” then we can just tell them the total.


Clients determine the quality and value of your practice within the first three minutes of entering your front door and, in many cases, they might even make this determination before they contact you, by reading reviews on the internet or talking to friends or relatives. Unfortunately, clients are not able to determine the true quality and excellence of your practice – they can only make this determination based on what they see and observe.

It is imperative that everyone on your healthcare team be aware of this concept of perception of value and look at the client experience through the eyes of your client. It is my hope that your practice truly renders a high quality of medicine and surgery and that your practice’s perception of value compliments and matches that, as well.

Mark Opperman, CVPM
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